Pneumonia is a dangerous illness at any age: victims often struggle to draw breath, and it can be fatal in many instances. To this end, receiving a vaccination against pneumonia seems to be a matter of common sense. However, some experts recommend that elderly people receive two vaccinations in order to maximize their chances of surviving an encounter with this pernicious illness.
Why get vaccinated twice?
To understand the merits of the idea of getting two vaccines for pneumonia, it is important to understand how a vaccine works. Generally speaking, when an individual receives a vaccine, he or she receives an injection of a specific type of illness-causing organism. These organisms have been greatly weakened or even killed outright in order to minimize the risk that they could cause an actual infection.
When the body encounters these organisms, it mobilizes an immune response in order to attack and destroy the foreign bodies. In the process, the body learns to identify and "remember" the organism and retain the ability to more quickly respond to and destroy any organisms of that type that it encounters in the future. This is the reason why most people only get any given serious illness (such as chicken pox) one time in their lives; after that, the body's defense system is able to quickly identify, attack, and destroy the given organisms before they can cause an infection or other symptomatic responses.
Returning to the topic of a pneumonia vaccination, the question remains: why get two vaccinations if the body is supposed to retain the benefit from the initial vaccination for a considerable period of time (if not the entire life span)? Simply put, it is because the term "pneumonia" refers to a number of conditions in which the lungs may become infected. Indeed, pneumonia can be caused by more than one type of organism, meaning that a vaccine against organism "A" will not protect against an infection caused by organism "B." A full exploration of the various organisms that can cause pneumonia--as well as the various kinds of pneumonia to which one may fall prey--is beyond the scope of this article. It suffices to say that people should be vaccinated against the most common types of pneumonia agents, and this may require two different types of vaccination.
What types of vaccines are best?
There are two main types of pneumonia vaccines: pneumococcal polysaccharide vaccine 23 (PPSV23) and pneumococcal conjugate vaccine 13 (PCV13). Until recently, most experts suggested that individuals over the age of 65 as well as individuals over the age of 2 who were considered to be at high risk of contracting pneumonia get a single dose of the PPSV23 vaccine. Generally speaking, the single dose was sufficient to provide protection from any future encounters with pneumonia-causing organisms.
Recently, however, a clinical trial by the name of CAPiTA, showed that an additional dose of PCV13 provided protection against some types of infections that may not have been protected against by the PPSV23 vaccine. This has led a number of experts--not the least of which is the Centers for Disease Control--to begin calling for elderly patients to consider getting both vaccines in a staggered time frame. Doing so will provide layered protection against pneumonia and will help to ensure the health and safety of the elderly population.
What should the timing and order of the vaccinations be?
As it turns out, the order of the vaccines actually may make a difference in providing the maximum amount of protection as quickly as possible. This is primarily because of the time one must wait after receiving one of the vaccines before receiving the second. After being vaccinated with PPSV23, a person needs to wait at least a year before being vaccinated with PCV13; on the other hand, if the person is vaccinated with PCV13 first, he or she will only need to wait six months before receiving the PPSV23 vaccination.
For this reason, if a person has not received either one of the vaccinations, he or she should first get the PCV13 vaccine, and then follow up in six months to receive the PPSV23 vaccine. If, like many elderly patients, one has already been vaccinated with PPSV23, he or she can get the PCV 13 vaccine at any time (so long as it has been at least a year since the PPSV23 vaccination) and the person will enjoy the benefits of both vaccines.
While being vaccinated with only PPSV23 will provide significant protection against most of the organisms that cause pneumonia, the person will still be susceptible to certain types of infections. For this reason, a person should make sure to get both vaccinations as quickly as possible. People most likely won't suffer any adverse effects from the vaccinations, but in some cases there may be a slight fever. In any case, getting both will help protect one from pneumonia, and will help one lead a longer and fuller life.
Pen, M. J. M., Huijts, S.M., Bolkenbaas, M., Webber, C., Patterson, S., Gault, S., van Werkhoven, C.H., et al. (March 19, 2015). Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults. The New England Journal of Medicine, (372): 1114-1125. DOI: 10.1056/NEJMoa1408544. Available at http://www.nejm.org/doi/full/10.1056/NEJMoa1408544#t=articleTop. Retrieved July 13, 2016.
Tomczyk, S., Bennett, N.M., Stoecker, C., Gierke, R., Moore, M.R., Whitney, C.G., Hadler, S., Pilishvili, T. (September 19, 2014). Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged >=65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control. Morbidity and Mortality Weekly Report 63(37);822-825. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6337a4.htm. Last visited July 13, 2016.